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. 2021 Sep 6;21(1):1628.
doi: 10.1186/s12889-021-11661-4.

Unhealthy lifestyles, environment, well-being and health capability in rural neighbourhoods: a community-based cross-sectional study

Anabela Marisa Azul  1   2   3 , Ricardo Almendra  4   5 , Marta Quatorze  6 , Adriana Loureiro  4 , Flávio Reis  7   6   8   9 , Rui Tavares  10   7   11 , Anabela Mota-Pinto  6   12 , António Cunha  13   14 , Luís Rama  15 , João Oliveira Malva  7   6   8   14 , Paula Santana  4   5 , João Ramalho-Santos  16   17   18 ; HeaLIQs4Cities consortium
Collaborators, Affiliations

Unhealthy lifestyles, environment, well-being and health capability in rural neighbourhoods: a community-based cross-sectional study

Anabela Marisa Azul et al. BMC Public Health. .

Abstract

Background: Non-communicable diseases are a leading cause of health loss worldwide, in part due to unhealthy lifestyles. Metabolic-based diseases are rising with an unhealthy body-mass index (BMI) in rural areas as the main risk factor in adults, which may be amplified by wider determinants of health. Changes in rural environments reflect the need of better understanding the factors affecting the self-ability for making balanced decisions. We assessed whether unhealthy lifestyles and environment in rural neighbourhoods are reflected into metabolic risks and health capability.

Methods: We conducted a community-based cross-sectional study in 15 Portuguese rural neighbourhoods to describe individuals' health functioning condition and to characterize the community environment. We followed a qualitatively driven mixed-method design to gather information about evidence-based data, lifestyles and neighbourhood satisfaction (incorporated in eVida technology), within a random sample of 270 individuals, and in-depth interviews to 107 individuals, to uncover whether environment influence the ability for improving or pursuing heath and well-being.

Results: Men showed to have a 75% higher probability of being overweight than women (p-value = 0.0954); and the reporting of health loss risks was higher in women (RR: 1.48; p-value = 0.122), individuals with larger waist circumference (RR: 2.21; IC: 1.19; 4.27), overweight and obesity (RR: 1.38; p-value = 0.293) and aged over 75 years (RR: 1.78; p-value = 0.235; when compared with participants under 40 years old). Metabolic risks were more associated to BMI and physical activity than diet (or sleeping habits). Overall, metabolic risk linked to BMI was higher in small villages than in municipalities. Seven dimensions, economic development, built (and natural) environment, social network, health care, demography, active lifestyles, and mobility, reflected the self-perceptions in place affecting the individual ability to make healthy choices. Qualitative data exposed asymmetries in surrounding environments among neighbourhoods and uncovered the natural environment and natural resources specifies as the main value of rural well-being.

Conclusions: Metabolic risk factors reflect unhealthy lifestyles and can be associated with environment contextual-dependent circumstances. People-centred approaches highlight wider socioeconomic and (natural) environmental determinants reflecting health needs, health expectations and health capability. Our community-based program and cross-disciplinary research provides insights that may improve health-promoting changes in rural neighbourhoods.

Keywords: Built environment; Health capability; Health loss; Healthy lifestyles; Natural environment; Non-communicable diseases; Participatory community-based research; Qualitative driven mixed-methods; Rural areas.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Location of rural neighbourhoods; basemap is provided by ESRI, available as part of the mapping platform ArcGIS Online
Fig. 2
Fig. 2
Community program intervention design; credits: the research team
Fig. 3
Fig. 3
Evidence-based data by rural neighbourhood for participants aged 55 to 74 years
Fig. 4
Fig. 4
Individual’s reflections about community circumstances influencing health and well-being in their rural neighbourhood
See this image and copyright information in PMC

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